Musculature of the Soft Palate: Clinico-anatomic Correlations and Therapeutic Implications in the Treatment of Cleft Palates

1997 ◽  
Vol 34 (3) ◽  
pp. 189-194
Author(s):  
Christian Vacher ◽  
Bernard Pavy ◽  
Jeffrey Ascherman
Keyword(s):  
Surgical Technique ◽  
Cleft Palate ◽  
Nasal Mucosa ◽  
Soft Palate ◽  
Hard Palate ◽  
Surgical Repair ◽  
Posterior Border ◽  
Therapeutic Implications ◽  
Sagittal Orientation

Objective Hypoptasia of the maxilla, often described as a classic sequela to surgical repair of the cleft palate, has been rare In our experience. We believe that our surgical technique, which includes dividing the nasal mucosa and the abnormal muscular insertions at the posterior border of the hard palate, is an important factor in preventing this sequela. Method We compared the anatomy of 12 normal palates in cadavers to the anatomy of cleft palates seen at operation and to the anatomy of one cleft palate in a fetus aged 34 weeks. Results In cleft palates, the muscular fibers have an abnormal sagittal orientation, inserting on the posterior border of the hard palate. Conclusion The division of both the nasal mucosa and these abnormal muscular insertions at the posterior border of the hard palate enables the surgeon to eliminate the abnormal posterior pull of these fibers on the maxilla.

The State of the Art in Cleft Palate Surgery

2000 ◽  
Vol 37 (3) ◽  
pp. 225-228 ◽  
Author(s):  
Don Larossa
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Surgical Repair ◽  
State Of The Art ◽  
Historical Context ◽  
Current Understanding ◽  
Multiple Methods ◽  
Advantages And Disadvantages ◽  
Palate Repair

Overview This update focuses on current practices and controversies in surgical repair of the hard and soft palate posterior to the alveolus. Our current understanding of the advantages and disadvantages of presurgical active and passive manipulation of the hard palate shelves including the use of periosteoplasty is reviewed. The evolution of the multiple methods of repair of the hard and soft palate is given in a historical context along with a discussion of the concerns about timing of palate repair.

Histologic Study of Intravelar Structures in Normal Human Adult Specimens

2005 ◽  
Vol 42 (5) ◽  
pp. 481-489 ◽  
Author(s):  
David P. Kuehn ◽  
Jerald B. Moon
Keyword(s):  
Soft Palate ◽  
Hard Palate ◽  
Tissue Composition ◽  
Posterior Border ◽  
Histologic Study ◽  
Levator Veli Palatini ◽  
Composition And Structure ◽  
Uniform Function ◽  
Substantial Investment ◽  
Normal Human

Objective To describe more clearly the tissue composition and structure of the human soft palate with particular emphasis on the central portion between the faucial pillars. Specimens Nine female and three male normal adult human soft palate cadaver specimens. Results The anterior soft palate consists of fairly uniform layers. The anterior one fourth contains a substantial investment of mucous-secreting glandular tissue, as well as an abundance of adipose tissue. The tensor veli palatini tendon is prominent in the most anterior region just posterior to the hard palate and close to the nasal surface. The middle one third of the soft palate is largely invested with muscle tissue consisting of (1) levator veli palatini fibers coursing transversely across the midline without a septal interruption, (2) musculus uvulae fibers encapsulated in a sheath and coursing longitudinally, perpendicular to and cradled by the levator sling, and (3) palatopharyngeus fibers located laterally and not approaching the midline. Musculus uvulae is variable across and within specimens in terms of its paired versus unpaired nature. Conclusions The anatomy of the soft palate from the posterior border of the hard palate to the levator veli palatini sling is consistent among specimens, suggesting that structures in this region have a uniform function across subjects. The paired versus unpaired nature of musculus uvulae is variable both within and between specimens. The posterior one third of the soft palate is variable across specimens with regard to the relative amount and distribution of different tissue types.

Speech Outcomes in Isolated Cleft Palate: Impact of Cleft Extent and Additional Malformations

2002 ◽  
Vol 39 (4) ◽  
pp. 397-408 ◽  
Author(s):  
Christina Persson ◽  
Anna Elander ◽  
Anette Lohmander-Agerskov ◽  
Ewa Söderpalm
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Reference Group ◽  
University Hospital ◽  
Perceptual Judgment ◽  
Cross Sectional ◽  
Velopharyngeal Function ◽  
Isolated Cleft Palate ◽  
The Impact

Objective The purpose of the study was to study the speech outcome in a series of 5-year-old children born with an isolated cleft palate and compare the speech with that of noncleft children and to study the impact of cleft extent and additional malformation on the speech outcome. Design A cross-sectional retrospective study. Setting A university hospital serving a population of 1.5 million inhabitants. Subjects Fifty-one patients with an isolated cleft palate; 22 of these had additional malformations. Thirteen noncleft children served as a reference group. Interventions A primary soft palate repair at a mean of 8 months of age and a hard palate closure at a mean age of 4 years and 2 months if the cleft extended into the hard palate. Main outcome Measures Perceptual judgment of seven speech variables assessed on a five-point scale by three experienced speech pathologists. Results The cleft palate group had significantly higher frequency of speech symptoms related to velopharyngeal function than the reference group. There were, however, no significant differences in speech outcome between the subgroup with a nonsyndromic cleft and the reference group. Cleft extent had a significant impact on the variable retracted oral articulation while the presence of additional malformations had a significant impact on several variables related to velopharyngeal function and articulation errors. Conclusion Children with a cleft in the soft palate only, with no additional malformations, had satisfactory speech, while children with a cleft palate accompanied by additional malformations or as a part of a syndrome should be considered to be at risk for speech problems.

Morphologic Significance of Bifid Uvula

PEDIATRICS ◽  
1985 ◽  
Vol 75 (3) ◽  
pp. 553-561
Author(s):  
Robert J. Shprintzen ◽  
Richard H. Schwartz ◽  
Avron Daniller ◽  
Lynn Hoch
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Velopharyngeal Insufficiency ◽  
Pediatric Practice ◽  
Submucous Cleft Palate ◽  
Hypernasal Speech ◽  
Definition Of

Bifid uvula is often regarded as a marker for submucous cleft palate although this relationship has not been fully confirmed. The reason for the tacitly assumed connection between these two anomalies has, in part, been perpetuated by the generally accepted definition of submucous cleft palate as the triad of bifid uvula, notching of the hard palate, and muscular diastasis of the soft palate. Recently, investigations have provided evidence of more subtle manifestations of submucous cleft palate by the use of nasopharyngoscopic examination of the palate and pharynx. It has been determined that submucous cleft palate can occur even when a peroral examination shows an intact uvula. This finding places the "marker" relationship in question. In order to determine the frequency of association between bifid uvula and submucous clefting, a total ascertainment of children with bifid uvula from a suburban pediatric practice was examined nasopharyngoscopically. It was determined that in all but two cases, children with bifid uvula had some or all of the landmarks of submucous cleft palate. Several of the children were found to have velopharyngeal insufficiency and mildly hypernasal speech. This finding prompts caution in the recommendation of adenoidectomy in the presence of bifid uvula.

On the Frequency of Oronasal Fistulation After Primary Cleft Palate Repair

2019 ◽  
Vol 56 (10) ◽  
pp. 1302-1313
Author(s):  
Ana Tache ◽  
Maurice Y. Mommaerts
Keyword(s):  
Systematic Review ◽  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Oronasal Fistula ◽  
Type Iv ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Fistula Rate

Objective: The aims of the study were to assess the postoperative oronasal fistula rate after 1-stage and 2-stage cleft palate repair and identify risk factors associated with its development. Design: Systematic review. Setting: Various primary cleft and craniofacial centers in the world. Patients, Participants: Syndromic and nonsyndromic cleft lip, alveolus, and palate patients who had undergone primary cleft palate surgery. Intervention: Assessment of oronasal fistula frequency and correlation with staging, timing, and technique of repair, gender, and Veau type. The results obtained in this systematic review were compared with those in previous reports. Outcome: The main outcome is represented by the occurrence of the oronasal fistula after 1-stage versus 2-stage palatoplasty. Results: The mean fistula percentage was 9.94%. In the Veau I, II, III, and IV groups, the respective fistula rates were 2%, 7.3%, 8.3%, and 12.5%. Oronasal fistula locations based on the Pittsburgh Fistula Classification System were soft palate (type II), 16.2%; soft palate–hard palate junction (type III), 29.3%; and hard palate (type IV), 37.3%. There were no statistically significant differences between 1-stage and 2-stage palatoplasty, syndromic and nonsyndromic, or male and female patients. Primary palatoplasty timing was not a significant predictor. Conclusion: Some disparities arose when comparing studies, mainly regarding location and types of clefting prone to oronasal fistulation. Interestingly, the fistula rate does not differ between 1- and 2-stage closure, and timing of the repair does not play a role.

scholarly journals A Pitfall in Prenatal Ultrasonic Detection of Submucous Cleft Palate

2020 ◽  
pp. 014556132097486
Author(s):  
Jia-Qi Hu ◽  
Yu-Guo Zhang ◽  
Wei Feng ◽  
Hua Shi
Keyword(s):  
Prenatal Diagnosis ◽  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Detailed Examination ◽  
Bony Defect ◽  
Ultrasound Screening ◽  
Fetal Ultrasound ◽  
Submucous Cleft Palate ◽  
3D Ultrasonography

Objective: We present a case with prenatal diagnosis of submucous cleft palate (SMCP) which was described using 2- and 3-dimensional (3D) ultrasonography in utero. Case Report: A 25-year-old pregnant woman was referred to our department for fetal ultrasound screening. After the detection of cardiac and spinal malformations of fetal, further detailed examination detected SMCP, which showed a gap within the hard palate on axial transversal view with the soft palate visible on sagittal view. The imaging of a defective hard palate in prenatal 3D ultrasonography is similar to that in postmortem 3D computed tomography reconstruction. Conclusion: A gap within the hard palate and verification of the visibility of the soft palate should be key points in the prenatal diagnosis of SMCP. Three-dimensional ultrasonic imaging is helpful for displaying the shape and extent of the bony defect in SMCP.

scholarly journals Simultaneous Repair of Cleft Hard Palate by Vomer Flap along with Cleft Lip in Unilateral Complete Cleft Lip and Palate Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Kazi Md. Noor-ul Ferdous ◽  
M. Saif Ullah ◽  
M. Shajahan ◽  
M. Ashrarur Rahman Mitul ◽  
M. Kabirul Islam ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Operation Time ◽  
Fistula Formation ◽  
Posterior Border ◽  
Oronasal Fistula ◽  
Vomer Flap

The purpose of the study was to see the short-term outcome of simultaneous repair of cleft lip and cleft hard palate with vomer flap against cleft lip repair alone in patients with unilateral complete cleft lip and palate (UCLP). A prospective observational study was carried out in 35 patients with unilateral complete cleft lip and palate who under-went cleft lip and cleft hard palate repair with vomer flaps simultaneously. After 3 months, cleft soft palate was repaired. During 1st and 2nd operations, the gap between cleft alveolus and posterior border of the cleft hard palate was measured. Postoperative complications, requirement of blood transfusion during the operation, and duration of operations were also recorded. Simultaneous repairs of cleft lip and closure of cleft hard palate with vomer flaps are easy to perform and are very effective for the repair of cleft lip and palate in UCLP patients. No blood transfusion was needed. Gaps of alveolar cleft and at the posterior border of hard palate were reduced remarkably, which made the closure of the soft palate easier, decreased operation time, and also decreased the chance of oronasal fistula formation.

Morphological Characterization of the Levator Veli Palatini Muscle in Children Born with Cleft Palates

2001 ◽  
Vol 38 (5) ◽  
pp. 438-448 ◽  
Author(s):  
Rolf Lindman ◽  
Gunnar Paulin ◽  
Per S. Stål
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Surgical Repair ◽  
Fiber Type ◽  
Muscle Spindles ◽  
Morphological Characterization ◽  
Velopharyngeal Insufficiency ◽  
Normal Adult ◽  
Levator Veli Palatini

Objective: The aim of this study was to analyze, morphologically and biochemically, one of the soft palate muscles, the levator veli palatini (LVP), in children born with cleft palate. Subjects and Methods: Biopsies were obtained from nine male and three female infants in connection with the early surgical repair of the hard and soft palate. Samples from five adult normal LVP muscles were used for comparison. The muscle morphology, fiber type and myosin heavy chain (MyHC) compositions, capillary supply, and content of muscle spindles were analyzed with different enzyme-histochemical, immunohistochemical, and biochemical techniques. Results: Compared with the normal adult subjects, the LVP muscle from the infantile subjects with cleft had a smaller mean fiber diameter, a larger variability in fiber size and form, a higher proportion of type II fibers, a higher amount of fast MyHCs, and a lower density of capillaries. No muscle spindles were observed. Moreover, one-third of the biopsies from the infantile subjects with cleft LVP either lacked muscle tissue or contained only a small amount. Conclusions: The LVP muscle from children with cleft palate has a different morphology, compared with the normal adult muscle. The differences might be related to different stages in maturation of the muscles, changes in functional demands with growth and age, or a consequence of the cleft. The lack of contractile tissue in some of the cleft biopsies offers one possible explanation to a persistent postsurgical velopharyngeal insufficiency in some patients, despite a successful surgical repair.

Cleft Palate Repair Using a Marginal Musculo-Mucosal Flap

2006 ◽  
Vol 43 (6) ◽  
pp. 651-655 ◽  
Author(s):  
Hisao Ogata ◽  
Tatsuo Nakajima ◽  
Fumio Onishi ◽  
Ikkei Tamada ◽  
Makoto Hikosaka
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Primary Repair ◽  
Formation Rate ◽  
Fistula Formation ◽  
Mucosal Flap ◽  
Periosteal Flap ◽  
Oronasal Fistula ◽  
Palate Repair

Objective: To describe a modified procedure consisting of a mucoso-periosteal flap palatoplasty with a marginal musculo-mucosal flap (3M flap). This is also the first report of a primary repair for complete cleft palate using the 3M flap. We describe the lengthening effect of the nasal mucous layer of the soft palate and evaluate the fistula formation rate associated with this method. Methods: This procedure has been performed on 21 patients with unilateral complete clefts and on 27 patients with incomplete clefts. A mucoso-periosteal flap raised from the hard palate was used mainly for closure of the cleft and not for the push-back. The 3M flap repaired the deficit of the nasal mucosa, making sure that the soft palate was lengthened. Intravelar veloplasty was performed also. Results: The dimension of the nasal mucosal defect that can be filled with the 3M flap is 10 to 12 mm in length, oriented anterior-posterior, and 15 to 20 mm wide. Oronasal fistula formation was recognized in only 3 of 48 cases (2 of 21 complete clefts, 1 of 27 incomplete clefts) and were located at the hard-soft palate junction at the anterior portion of the 3M flap. Conclusions: This method has the theoretical advantages of (1) preventing fistula formation by filling the tissue deficiency with the 3M flap; (2) achieving better velopharyngeal function due to elongation of the soft palate and retropulsion of the muscular bundle, utilizing the 3M flap; and (3) minimizing maxillary growth retardation by adopting a non–push-back method of hard palate repair.

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